Make It Last – Ep 83 – Last Call for Medicare Open Enrollment & Interview with Kat & Kelly of Independence Home Care

Make It Last – Ep 83 – Last Call for Medicare Open Enrollment & Interview with Kat & Kelly of Independence Home Care

We are coming up on the last days for Medicare open enrollment. You will have until December 7th to enroll so if you have not done so yet, there is still time. Take a listen to the first half of this show as Victor explains the importance of enrolling on time and suggests going back to episode 74 to listen to the interview with Carol Baker of CABA Benefits, as she shared her wealth of knowledge of all things Medicare.

In the second half of the show, Victor continues the holiday season series. Now is the time where families are getting together and have an opportunity to see older family members during the holidays. During this time they may begin to recognize some form of decline, whether it be cognitively, physically, or a little bit of both. Kat & Kelly of Independence Home Care speak on their area of expertise, home care. They share valuable information, from how to know when someone needs home care to how to shop for a home care agency.

If you would like more information about Independence Home Care you can visit their website.

Make It Last with Victor Medina is hosted by Victor J. Medina, an estate planning and Certified Elder Law Attorney (CELA®) and Certified Financial Planner™ professional (CFP). Through his law firm and independent registered investment advisory company, Victor provides 360º Wealth Protection Strategies for individuals in or nearing retirement.

Victor Medina: Hey everybody, welcome back to Make It Last. I’m your host, Victor Medina. I’m so glad that you can join us this Saturday morning.

I’m excited for today’s show because we’ve got a couple of special guests that are going to join us as we continue our series where after Thanksgiving we introduced this idea that maybe you’re going to notice some family members getting a little bit older, maybe needing a little bit of help.

You might need some tips about what you can do to assist them and put them in the best possible position going forward. Last week, we had a doctor on talking to us about Alzheimer’s and some of the indications and some of the clinical trials that are available.

This week, we actually have got two special guests coming in from a home healthcare company called Independence Home Care. Our guests are Kat Verdi and Kelly Aylward.

They’re going to join us a little bit later on in the show and then share with us some ideas to think about when the older adult that’s in your life might need a little bit more care, might need some help around, and what to think about and look for when you are, essentially, shopping for those services.

Before we get into that segment, I wanted to share with you some information because we are at the point in the year where we need to be making some healthcare and Medicare‑related decisions. We still have some time left for people to be making some decisions through the Medicare open enrollment period.

Now, that opened back in October 15th. In fact, just prior to the opening of the Medicare open enrollment period, we had on a special guest. Her name was Carol. One of the things that I’m going to urge you to do is go back to one of those shows and listen to that if you want to learn more about Medicare supplements and Medicare, generally.

If you go back to that and listen to that show, remember you can do that by going to Apple iTunes or going to Spotify, subscribing to the podcast. You can even go to makeitlastradio.com and scroll back through the prior episodes. You’ll be able to go ahead and pick out the one where Carol Baker is on as a guest.

We opened the Medicare open enrollment period October 15th, and it runs through December 7th. The airdate for this show if you’re listening on the podcast afterwards is December 1st. We have a few more days that you can take advantage of the open enrollment period.

Basically, you can make changes to your coverage which will take effect on January 1st that you basically can’t do any other of the weeks of the year. This is a very short eight‑week period, and you can make changes on it.

Now, one of the first key changes that you can make, and it’s important in an annual review of your healthcare situation is assess whether or not you need to make changes to your Part D prescription drug plan.

What ends up happening is that providers themselves, so even if your drugs don’t change, the providers themselves do make changes to their formularies. Formulary is a fancy term for their list of preferred, more favorably‑priced drugs. They make changes to that.

That means that you might end up paying more next year for a drug that fell off of their formulary even if you didn’t change the prescriptions that you are taking. What you want to do is you want to go and make a review of that, especially if you had new drugs that are being prescribed to you, especially ones that might be expensive. [laughs]

I didn’t know any other way to say it, but they’re expensive. If you want to be able to pay the least amount possible, you want to go ahead and take a look at whether or not you need to make a switch to the Part D plan. Doing that is actually pretty easy. In fact, it’s not uncommon at all for the plans themselves to make changes and then people to follow on.

It’s important because what would happen is, and you should have been paying attention to your mail, is that by September of this prior year, in fact, of every year, if you’re enrolled in Medicare, you should be receiving what’s known as an evidence of coverage letter, an EOC document.

It provides details about plan coverages and expenses. You should also have received by September a plan annual notice of change or ANOC. This document explains changes from the plan that will change the coverage and the cost from one year to the next.

What happens a lot of the time is when that mail comes in, it looks like junk mail. People throw them out. You can go ahead and you can request an additional copy of that. Many times, it’s better to go to Medicare’s website and review and compare different plan information.

Again, because you may not be aware, I’m only going to give you that stuff in the document. You may not be aware of how they change their prescription formularies. Again, it can widely vary from one year to another.

What you want to do is you actually want to go to the Medicare plan finder website. The best way to do that is you go to medicare.gov, and you click on Find a Plan. What it’ll allow you to do is you can go ahead, and it’s like find health and drug plans on there.

What you can do is you can log into your My Medicare account if you haven’t created one. You can enter in your ZIP code. You can also end up putting in your Medicare number, which remember, changed. You got a card in the last year or so that gave you a Medicare claim number.

It’s no longer your Social Security number. When you put that information in, you should be getting a list of your drugs that were saves from one year to the next, or you can start to enter in those drugs. What you’ll do is you’ll enter in how much you’re taking, how much you’ve been prescribed, what dosage, how often you buy it.

You will tell the medicare.gov, that Plan D plan finder, you will tell them whether or not you do it by mail‑order or if you have favorite pharmacies that you like to go to. You want to enter all that information in. Not only will the formularies for the plans change, but then of course, their cost to the pharmacies to fulfill that changes.

You want to mix all of that stuff together. When you come up with a set of results, you want to dive in because it will list it from least expensive to most expensive. It’s a combination of your premium and then the out‑of‑pocket cost. That what they’re doing on that plan side is adding them all together.

What you want to do is open up the windows in there and get a better sense of how much is their plan cost, how much is the premium, and then how much are the out‑of‑pocket. If there’s any deductibles that you need to meet first so you understand even though they’re going to give it to you as an overall cost for the year, specifically what money is going from where.

Absolutely do that. You have until December 7th to do that, and then the Medicare enrollment period, essentially, ends. We want to make sure that you get that in definitely in time for that. Then the other thing that you’re able to do, by the way, there are penalties for late enrollment. If you’ve never enrolled in Medicare Part D, you need to be signing up for that during your initial enrollment period for Medicare.

That’s basically the three months prior to when you turn 65 and then three months after you turn 65. The magic phrase there is creditable drug coverage. If you had coverage from some other place, then it’s OK for you not to enroll in Medicare Part D. If you end up having something less than creditable coverage, then you have a late enrollment penalty.

This is the time to square that all up from all these sources so you don’t spend extra money. Then finally, you may want to consider switching from an original Medicare to a Medicare Advantage plan. This is a decision that I think requires working with an advisor that focuses on people in retirement because this is a tricky thing.

Usually, a Medicare Advantage plan, or what’s called a Medicare Part C, is a plan that is offered through a private insurance company. What they do is rather than this being the federal government Center for Medicare & Medicaid Services, this is a private company that is including their versions of Part A, Part B, and typically Part D coverage.

That would be the catastrophic coverage, the normal doctor’s appointments, and then the prescription coverage. The idea is you put them all together. The way the money flows is a little bit complicated. This is a form definitely of Medicare. It’s being covered by your premiums.

You need to investigate it, because first of all, you can’t go back and forth from one to the other. There are some underwriting risks that are in there. There are expenses that, while it looks like the Medicare Advantage plan covers everything, there are plans that don’t cover everything.

They might still require some Medigap policies. You want to make sure if you looked at Medicare Advantage, you’re getting something additional from that, maybe coverage for hearing aids or dental or vision expenses.

Again, you do want to make sure that you are investigating this with somebody who’s educated, either someone that focuses on Medicare Advantage plans or Medicare coverage, or an advisor that can put you in touch with that, that understands this. It is something that is an area of specialty for that.

I definitely recommend that you investigate that and get done that as soon as possible.

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Victor: We have a few more days before the close of the open enrollment period for Medicare. I hope I got you off your hindquarters and thinking about this, especially if you’re over 65 so that you don’t wake up with a nasty surprise for next year.

Listen, when we come back, we’re going to be joined by our special guests, Kat Verdi and Kelly Aylward from Independence Home Care. They’re going to talk to you a little bit about what happens when you notice an older adult who might need care and wants that care in the home. Join us. We’ll be right back after this quick break.

[commercial break]

Victor: Welcome back to Make It Last. My guests today are Kelly Aylward and Kat Verdi from Independence Home Care.

I’ve asked them to join us because in our continuing series of post‑Thanksgiving shows, as families gather and as people get an opportunity to see how family members are doing and realize, “It’s not so great. Maybe, there’s something that we need to do about it.”

The resources that they need to learn about become available to help them at that, you need to get educated on that.

First of all, thank you, Kelly and Kat, for joining me today.

Kelly and

Kat: Thank you for having us.

Victor: Tell us a little bit about Independence Home Care. What is it? Who does it serve? What makes it distinct?

Kat Verdi: Independence Home Care, we provide a home care service which is non‑medical, so custodial care, helping with activities of daily living. Our company is family‑owned and operated. We are not part of a franchise.

We are owned by Vinnie and Terri Sajkowski. Terri Sajkowski is actually the nursing director of the company and has a background in hospice.

Victor: Is there a particular geographic region that you all work on or focus on? The show here is in Central Jersey.

Kelly Aylward : We’re pretty much Central Jersey. We do hourly and live‑in care, which is 24‑hour care, live‑in, which would be around the clock, basically. We cover Mercer, Monmouth, and Middlesex County. We’re also going into Ocean as well.

Victor: I started this segment, and these shows have been…

I was thinking about Thanksgiving and when families gather. I said in last week’s show that nowadays you can see anything that happens on the Internet, so I know my Web traffic. It used to be that the day after a holiday, my Web traffic would go through the roof. Now, it’s the day of.

While you’re sitting there and you see that mom’s not so hot, you’re there Googling Elder Law Attorney. We see a whole bunch of stuff going in there. Has that been your experience as well? Have you seen that when families gather, that’s finally the opportunity where people are like, “It’s now time to think about should we bring in some help?”

Kelly and

Kat: Absolutely.

Kat: We see this every year. I’ve been in the industry for 10 years now. Usually around the holidays, starting from October, November, December, January, we see an increase in clients, a huge increase.

Victor: What causes that to happen? Are people trying to manage on their own and they finally can’t any longer, or they’re faced with evidence that said, “This is really something that needs to be attended to, Kat? What ends up happening?

Kat: For me, in my experience and my tenure, I come from the assisted living, independent living, rehab, and now finally where I’m truly helping people.

Victor: You have the full deck, every card in there, you’ve got a poker. You’re good there.

Kat: Absolutely. I think it was part of my journey, and I got to see a lot of challenges that became my passion for personal reasons. My uncle has Alzheimer’s. You have to be versed. Going back to the question, I think that is when people gather.

Thanksgiving being one of our American holidays, and people fly in. When you’re on the phone with mom and dad, I can attest to this, “Everything’s fine, everything’s wonderful,” until you go to that family gathering. A, you see how your parents are walking through the door. You see how they’re dressed.

That is when it is in your face and you realize, “Wait a minute. Now the flags are going off.” Now for the children that don’t live locally and are only here for the holiday, I think that’s where you see the heightened crisis mode, like, “We’ve got to do something.”

Victor: Culturally, we’ve shifted. There are some cultures that live close by and don’t move more than a mile down the road, but I think more and more, we’ve been spread out.

That opportunity where we gather again on these major holidays is the first chance that we get in our face what’s going on. People spread around, careers bring people outside. Marriages and developing family brings people further and further away.

You come back and you see that elder individual, that senior coming in and saying, “Finally, jeez, there’s something going on that I need to attend to.”

Kelly: Absolutely. Not only that, but I think that we have to be conscious that we’re a two‑income family. Those days of grandma coming to the house, they’re slim to none.

Victor: Where somebody can take care of them, where there’s somebody at home full‑time. Everyone’s graduated into need to having both members of that family work all the time. If you’re in a single family, you’re working, and you’re the only person that’s there.

Kat: Correct. I think to care for a loved one that may have greater needs, not only medication and being compliant with your medication, taking them to doctors. That’s when it all, I think, comes to a head, like, “Oh my gosh.”

Then you ask the question at Thanksgiving, “Mom, when was the last time you went to the doctor?” The, “Oh yeah, I was there nine months ago.” You’re like, “What,” another flag, definitely.

Kelly: When was the last time you took a bath? [laughs]

Victor: Sometimes you can tell that from across the room, though, right?

[laughter]

Kat: Totally.

Kelly: You don’t have to ask.

Victor: A lot of times, I think family members try to take on this responsibility on their own. They don’t look for professional help. They don’t see the value of that.

Where do you see the risk in having somebody who’s an untrained person or isn’t in that area performing those activities or taking on that responsibility? Where do you see that is being the largest risk?

Kat: I think for the homeowner. I’m all about aging in place, but what’s happening, and we see it time and time again is that you are.

You’re trusting someone that’s probably lovely that’s going to help mom or dad out, but then that person in the process of helping your loved one rolls an ankle, falls. I don’t think that people look at the big picture.

Now that’s a liability for that homeowner, for that person. You think you’re doing the right thing by getting someone to go to your parents’ home.

We know her from the family, word of mouth, whatever. That person doesn’t have the proper certifications that they need to have to help your loved one.

Victor: The risk then becomes first of all, not only is there no standardization of the kind of care that’s being provided. In other words, if you had an organization that was around providing home healthcare services, as opposed to just an individual that knows that they can go and live with somebody, that’s what they’ve been doing.

If it’s the organization is not around that, then you don’t have any confidence about what that standardization of care is going to be or what’s actually going to be provided. Is that a fair statement to what some of the risks are?

Kat: Definitely fair, but I think I’d like to take it to the next level. As a society, we are not programmed to say, “Hey what are our options?” We just don’t talk about it.

There’s a lot of options. There’s a lot of differences between different companies and their accreditations and what they put into their staff.

If your staff is happy, if you provide for your staff as an employer, you’re going to have longevity. That’s one of the things that I pride myself here at Independence Home Care.

Victor: Even as a practical matter, just the fact that there’s an entity and organization means that there’s backup. If they have that one person go down, not only do you have possibly liability issue, but jeez, there’s nobody else to be take care or, at least, the care becomes compromised if that person rolls an ankle or can’t work for a particular period of time.

What do you find, Kelly, as the biggest obstacle for families to overcome in terms of bringing on these services. When you meet with them and you say, “This is something that you ought to be doing.” What’s the largest obstacle that either you have to overcome with them, or that they have to overcome before they agree to do that?

Kelly: One of the times there the family member is nervous about bringing somebody into the home. We’d really want to make them comfortable and know that we work very hard at finding the right aide for them.

It’s a team approach. We make sure that we look at their personality, and we match it with the personality the aide that we have. That’s a really critical point right there. We work very hard on conversing about that throughout the team.

When it’s finally time to bring that person, we will also say you can meet them ahead of time. It makes them a little more comfortable when you’re bringing that caregiver in the home for the first time.

Victor: Can you give me a sense of what different kinds of personalities might look like? Generally we recognize like, “OK, people have different personalities,” but what are some of the ranges on the extreme of what you have to match to work?

Kelly: That’s a good point. You have some family members. They’re very particular on their ways in their home. They’re a little more OCD. They want things a certain way.

We have to make sure that the aide that that we put with them is going to be a patient person, somebody that’s going to really take their time and listen to their needs, and make sure they’re fine‑tuning everything that they want. They want that toothbrush put back in that box. That’s where it belongs.

Victor: That’s my dad.

Kelly: It’s those little things that really go a long way because in the end, they will be the make it or break it. If we do see that, maybe, there isn’t a good personality match in the beginning, we’ll switch that aide out right away.

For the most part, we try to get it right. 99 percent of the time, I would say, we made the right match.

Victor: Let me shift gears a little bit. There are any number of people who provide home healthcare agency services. I have been on the show before saying, “It seems to be on the cover of ‘Franchise Magazine’ as Top Franchises to Own and it’s home healthcare agencies. It’s up there with the Jiffy Lubes.

Kat: [laughs]

Victor: It’s one and two. If you just want to have a franchise, or you’re going to make some subway sandwiches, or you’re going to change oil, or you’re going to provide home healthcare agency services.

Independence Home Care is family‑owned which I know makes it distinct in terms of it’s not on the franchise model. What are some of the risks that are associated with that? You’re basically at the behest of whoever the owner is.

I don’t want to necessarily denigrate anybody that’s in there, but there’s got to be some risks to really not understanding if you’re in a franchise model that the name alone, that you might have seen on an advertisement on daytime TV, isn’t determining what kind of level care you have.

How do you compare, how you shop, and how do you look for that? Obviously, Independence Home Care has got as one of its distinguishing features that it’s family‑owned, that is not answering to a licensing fee and a payback of a loan with high rates or something, however their financing is.

Tell me a little bit more about what those risks are in the franchise model and is it possible to avoid them?

Kat: I think so. Again, going back to having the consumer be educated and know what they’re looking for. For example, one of the things that we do, not only do we match the client with the caregiver, but on our HR ends, we do a thorough background check on everyone that is going to be employed by Independence Home Care.

We do not hire anybody that doesn’t have, at least, in a minimum, two years’ experience.

Victor: Oh wow.

Kat: They take a personality test. We run the licenses. We do a lot of background work that I don’t know what the policy may be for a franchise that does what we do.

That goes a long way when we sit with our clients and the children of. Let’s face it, very, very minimal times do we have a senior person’s like, “Hey I need your services.” It’s usually like, as we said earlier, it’s the children.

One of the things that I also enjoyed, I wish Independence Home Care was around when I needed them, but they weren’t in Jersey City where I’m originally from. They have a beautiful binder. When we say that we are bonded and insured, here’s our copy of what we’re saying.

Everything that we say, we are an open book. No pun intended. We share with our clients. I don’t know that that’s the case.

Victor: I spent a lot of time on the show talking about the need for people to bring in fiduciaries on the financial side, because so many people who provide services aren’t fiduciaries. They’re not obligated to look out for the best interests.

That goes to a lack of transparency in that industry that you don’t know what you’re paying for, how someone’s being compensated. I think that sunshine cleanses all.

The more transparency that you have about, you want to know if they’re bonded or licensed. Here’s a copy of our certificate that establishes that, or here’s our process for how we bring somebody on. It’s not just that we’re constantly running ‑‑ I don’t know if it’s Craigslist anymore, but whatever. We’re constantly running ads.

Somebody said, “You want to be an aide, and can you get on a bus line?” Kind of thing for that.

We talk a little bit about the challenges of what it takes to bring somebody into the home and what those risks are. What are some of the benefits to doing that? What could people expect if they’re a little bit more open to bringing on help along the way?

Is it a matter of stabilization? Is it a matter of nosing up on a decline just because people can get more normalized along there? Where do people see that benefit for them? Another set of eyes?

Kat: We’re in this business because we want to make sure that people are home. They’re in their home. They’re healthy, they’re happy, they’re thriving. They’re able to live longer when they’re in their home. You go to a facility or a nursing home, and the decline starts.

It’s nice to see a family member that is in their home. My grandmother was in her house with homecare as well, and she did fantastic. She really did well. One of the nice things is there is always somebody there.

Like you said, it’s a second set of eyes to make sure that you’re not smothering them, but you’re making sure that they are safe in their home. They’re eating properly. They’re taking their medications. Their linens are clean. Their laundry’s done. The house is neat. There’s no obstacles for them.

As far as full risks or anything like that, we make sure that they’re truly safe. In addition, we also have a lot of the homecare agencies, not all of them, but are, as we do, go out every 30 days, will have a registered nurse go out and do an assessment. Check in, make sure the aide is following the plan of care, and our client is as well.

Those two things are very important. We don’t charge extra for that. Also, if you were to call us and the client’s not feeling well, the aide calls us and says, “It seems like she has a fever. We’re not sure.” We’ll have her nurse go there that same day.

Check in on her, no charge for that at all. Just to make sure that she’s OK. She doesn’t have to go to the hospital where she’ll decline even more. We want to keep her in the home. With all of that, it’s really important. It’s huge.

Victor: When you look at the aging of the population ‑‑ what is it ‑‑ 10,000 baby boomers turn 65 every day from now until the year, 2040. The need to get comfortable with this level of services to see what that benefit is so that this independence that people have had for their entire life doesn’t necessarily have to go away.

If their family members are gone, that doesn’t mean that they have to move to where they are that they can get those services. It’s remain in the life that they created. Then the more that we get open to this idea, the better that we’re all going to be for that because we’re just going to see this population boom continue and the needs for these services grow and continue as well.

Maybe, that’s why it’s on Franchise Magazine, somebody’s looking at actuarial tables. There is going to be a growing need for this along the way. I can see why or how learning about it and being prepared for, being open to it can really benefit everyone involved.

Kat: Absolutely. Not only that, but the state has taken a little bit of step to put these mandates. As of July, 2019, a lot of these homecare agencies have to be accredited. We have been accredited. What does that mean to a consumer? There’s a little link that I can provide a little bit later.

You want to be accredited because when you’re accredited, you go far and beyond the regular mandates of the state. Like what Kelly said earlier, if you’re just a homecare agency and obviously you’re following all the regulations of New Jersey, you have to go and visit. An RN has to go visit in 60 days. When you are CHAP accredited like we are, we do it every 30 days.

Victor: I’ve used that as a really great sign. Sometimes people’s behavior tips you to what you want. Like I say to people, “Look, if they’ve gone out and gone x‑credential, it’s completely unnecessary but it indicates that they’re really focused in being in this area.

If you find a homecare agency that’s accredited, even though they’re not required to be, you get some level of how serious they are in that field and what they consider to be important. It’s important, not just to have the credential maybe to show off, but that what it brings with it, a higher level of care for their charges and who they’re responsible for.

If people want to learn more information about Independence Home Care, how can they contact you and learn more about that?

Kat: They can go to our website which is www.independencehomecare.com, or you can call us at 609‑208‑1111, and you can also stop in the office if you want. We are in Monroe at 348 Applegarth Road.

Victor: You guys are in the heart of everyone that might be turning old and need somebody. In Monroe, you can’t stumble over retirement communities, so you guys are perfectly located.

I want to thank you, Kat and Kelly, for being our guests today. This has been a fantastic show. Again, if you have any information that you want to learn about home healthcare, visit indepencehomecare.com…

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Victor: …or contact them by phone, or as Kelly suggested just drop in. I’m sure they’ll have a cup of coffee or water for you if you do that.

About Victor Medina

Victor J. Medina, managing attorney of Medina Law Group, devotes his practice to estate planning, helping parents and grandparents to leave their wealth to whom they want, when they want them to have it, and in the way they want.